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If the Senate’s threat became a reality, the state would lose over $9 billion in health subsidies.

And that’s just in 2012.

No Medicaid for you!

Republican House Speaker Dean Cannon isn’t so sure he’s on board with that, so the exercise may be nothing more than political poker. But that’s one helluva game.
The most likey change in the Senate bill requires most people on Medicaid to enroll in private managed care coverage, and pay a $10 a month premium. (not the developmentally disabled or those in institutions.)

The insurance companies would have to commit to spending 90 cents of every $1 on actual medical care as opposed to overhead.

To encourage more primary care doctors to take Medicaid, it would promise much higher payments to family doctors – nearly double – and give them new protections from lawsuits. That’s another point where the House and the Senate appear to disagree.

The bill contains a little-noticed Sword of Damocles:

An unnamed state agency, presumably AHCA’s successor, would be directed to rewrite the state’s Medicaid plan to meet budget, whatever that will be, making necessary cuts in this order:

The Legislative Budget Commission would have to agree to the final cost-cutting plan.

Assuming the state and U.S. work out their differences and Armageddon isn’t invoked, the Senate bill would make enrollment in KidCare, a catchall insurance basket for children which includes Medicaid, easier. It would allow reduced-price school lunch paperwork to serve the purpose of proving eligibility.

It would toughen Medicaid fraud fighting, by forcing recipients to agree to have their medical records reviewed by fraud investigators, and barring anyone involved in a fraud scheme from collecting benefits for 10 years.

As my colleague Dara Kam reported yesterday, it would require people on Medicaid to shape up or ship out.

Smokers would have to participate in smoking cessation programs, the morbidly obese would have to enroll in a medical weight-loss program, and addicts and alcoholics would have to enroll in substance abuse programs.

There’s no mention of a penalty.

Implied is the possibility that if they didn’t participate in a good-faith way in these programs, they’d lose their Medicaid coverage. Presumably their doctors would be the lucky ones making that Survivor-esqe determination.

Low-income workers whose employers offer insurance would have no choice. They’d be given a a state voucher to use toward the cost of their employer’s policy. No mention of standards that the employer policy would have to meet.

People on Medicare who used to be called “medically needy” are now called “recipients of Medicaid nonpoverty medical subsidies.” There are more than 400,000 such “dual eligibles” in the state. They would take a hard hit. The bill says they would be “eligible to receive physician services only.”

That appears to be code language for: The state won’t be paying your cancer drug copayments any more. Or payments for any other drugs your Medicare Part D plan refuses to pay.

That’s my first deep dive into the bill. Let me know if you see other elements that should be noted.